潜在性原因不明消化管出血患者に対するカプセル内視鏡の有用性と低用量アスピリン起因性小腸粘膜傷害に対するポラプレジンクの有効性 1.潜在性原因不明消化管出血に対するカプセル内視鏡の有用性 : 顕在性原因不明消化管出血との比較 2.カプセル内視鏡を使用した低用量アスピリン起因性小腸粘膜傷害に対するポラプレジンクの有効性

Thesis 1. Background/Aim. Usefulness of capsule endoscopy (CE) for diagnosing small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB) has been reported. Most reports have addressed the clinical features of overt OGIB, with few addressing occult OGIB. We aimed to clarify whether occult OGIB is a definite indication for CE. Methods. We retrospectively compared the cases of 102 patients with occult OGIB and 325 patients with overt OGIB, all having undergone CE. The diagnostic yield of CE and identification of various lesion types were determined in cases of occult OGIB versus overt OGIB. Results. There was no significant difference in diagnostic yield between occult and overt OGIB. +e small-bowel lesions in cases of occult OGIB were diagnosed as ulcer/erosive lesions (n = 18, 18%), vascular lesions (n = 11, 11%), and tumors (n = 4, 3%), and those in cases of overt OGIB were diagnosed as ulcer/erosive lesions (n = 51, 16%), vascular lesions (n = 31, 10%), and tumors (n = 20, 6(%). Conclusion. CE detection rates and CE identification of various small-bowel diseases do not differ between patients with occult versus overt OGIB. CE should be actively performed for patients with either occult or overt OGIB. Thesis 2. Background: Treatment of low-dose aspirin (LDA)-induced small-bowel injury has not been established. Polaprezinc, a chelate of zinc and L-carnosine, may be efficacious for such injury. We conducted a pilot randomized controlled study to investigate whether polaprezinc is effective against LDA-induced small-bowel injuries. Methods: Consecutive patients under long-term (>3 months) LDA treatment and who agreed to participate in our study underwent initial capsule endoscopy (CE). Patients with LDA-induced small-bowel injury apparent upon initial CE (n = 20) were randomized into a polaprezinc (150 mg/day for 4 weeks) group and a control (no polaprezinc treatment) group. All underwent follow-up CE after 4 weeks. Changes in the number and characteristics of small-bowel mucosal injuries were compared within and between the two groups. Results: The median number of reddened lesions and erosions/ulcers upon follow-up CE in the polaprezinc group significantly decreased (P < 0.05). However, there was no significant difference in the median number of reddened lesions and erosions/ulcers upon follow-up CE in the control group. Conclusions: Co-administration of polaprezinc may be effective against small-bowel mucosal injury associated with long-term LDA therapy.Thesis 1. Is occult obscure gastrointestinal bleeding a definite indication for capsule endoscopy? A retrospective analysis of diagnostic yield in patients with occult versus overt bleeding. Thesis 2. Effectiveness of polaprezinc for low-dose aspirin-induced small-bowel mucosal injuries as evaluated by capsule endoscopy : a pilot randomized controlled study.広島大学(Hiroshima University)博士(医学)Philosophy in Medical Sciencedoctora

Is Occult Obscure Gastrointestinal Bleeding a Definite Indication for Capsule Endoscopy? A Retrospective Analysis of Diagnostic Yield in Patients with Occult versus Overt Bleeding

Background/Aim. Usefulness of capsule endoscopy (CE) for diagnosing small-bowel lesions in patients with obscure gastrointestinal bleeding (OGIB) has been reported. Most reports have addressed the clinical features of overt OGIB, with few addressing occult OGIB. We aimed to clarify whether occult OGIB is a definite indication for CE. Methods. We retrospectively compared the cases of 102 patients with occult OGIB and 325 patients with overt OGIB, all having undergone CE. The diagnostic yield of CE and identification of various lesion types were determined in cases of occult OGIB versus overt OGIB. Results. There was no significant difference in diagnostic yield between occult and overt OGIB. The small-bowel lesions in cases of occult OGIB were diagnosed as ulcer/erosive lesions (n=18, 18%), vascular lesions (n=11, 11%), and tumors (n=4, 3%), and those in cases of overt OGIB were diagnosed as ulcer/erosive lesions (n=51, 16%), vascular lesions (n=31, 10%), and tumors (n=20, 6%). Conclusion. CE detection rates and CE identification of various small-bowel diseases do not differ between patients with occult versus overt OGIB. CE should be actively performed for patients with either occult or overt OGIB